Age of first drinking and adult alcohol problems: systematic review of prospective cohort studies

Abstract

BackgroundAlcohol policies around the world seek to delay the initiation of drinking. This is partly based on the influential idea that earlier initiation is likely to cause adult alcohol problems. This study synthesises robust evidence for this proposition.MethodsSystematic review of prospective cohort studies in which adolescent measurement of age of first drink in general population studies was separated by at least 3 years from adult alcohol outcomes. EMBASE, Medline, PsychINFO and Social Policy and Practice were searched for eligible studies, alongside standard non-database data collection activities. Data were extracted on included study methods and findings. Risk of bias and confounding was assessed for individual studies and a narrative synthesis of findings was performed.ResultsThe main finding was the meagre evidence base available. Only five studies were eligible for inclusion in this review. The existence of effects of age of first drink on adult drinking and related problems were supported, but not at all strongly, in some included studies, and not in others. Rigorous control for confounding markedly attenuates or eliminates any observed effects.ConclusionsThere is no strong evidence that starting drinking earlier leads to adult alcohol problems and more research is needed to address this important question. Policy makers should, therefore, reconsider the justification for delaying initiation as a strategy to address levels of adult alcohol problems in the general population, while also addressing the serious acute harms produced by early drinking.

Effects of increased alcohol availability during adolescence on the risk of all‐cause and cause‐specific disability pension: a natural experiment

“…Although there is a vast amount of research suggesting that adolescent alcohol consumption is a strong predictor of alcohol problems in adulthood, the underlying mechanisms of the relationship is not understood fully 16, 25. From a life‐course perspective, adolescence can be considered a sensitive time‐period where individuals are more vulnerable to various social and biological exposures, which can have an impact on health later in life 14, 38.…”

“…Some research suggests that individuals consuming alcohol already in early adolescence are more vulnerable to the long‐term health consequences compared to individuals who begin consuming alcohol in late adolescence 25, 26, 27, 28. Further, evidence suggests that the consequence of consuming alcohol is more severe among those with lower socio‐economic status 29, 30, but little is known about the potential differential responsiveness to a decrease in the legal age limit for alcohol purchases.…”

Usefulness of AFD concept: limitations to overcome

“…Among the 21 definitions described by Kuntsche et al [1], most of them attempt to characterize consumption as 'bigger than a few sips'. However, the only systematic review including prospective studies that used this AFD definition found only five studies, and concluded that there are insufficient data to draw definitive conclusions about the relationship between AFD and AD in adults [4]. In other words, there is need to reach a consensus within the scientific community about what is, and how to evaluate, AFD.…”

“…Rather than being a fatal weakness, the replication of those relations using a variety of terms suggests a robust association, which has been found in cross-sectional surveys [4][5][6], in some [7][8][9][10][11] but not all [12] longitudinal studies and studies that control for genetics [13], such as studies of identical twins [14].…”

The usefulness of ‘age at first drink’ as a concept in alcohol research and prevention

“…Rather than being a fatal weakness, the replication of those relations using a variety of terms suggests a robust association, which has been found in cross-sectional surveys [4][5][6], in some [7][8][9][10][11] but not all [12] longitudinal studies and studies that control for genetics [13], such as studies of identical twins [14].…”